Peanuts off menu at many schools, to protect kids with deadly allergy

The peanut-butter sandwich, that nutritious favorite of American schoolchildren, will not be on the menu this fall in a small but growing number of Puget Sound schools.

When classes resume in the next few weeks, dozens of schools will not offer anything with peanuts in school breakfasts or lunches. A few will go a step further and ask parents to refrain from sending peanut products in lunches from home.

The reason is that the peanut is a life-threatening enemy to a small minority of students.

An estimated 6 million to 7 million Americans have some kind of food allergy. About half of them are thought to be allergic to peanuts, technically part of the bean family, or to nuts such as walnuts.

Allergies of all kinds are on the rise, especially among children. But peanut allergies are a particular concern because they are the No. 1 cause of anaphylactic reactions — the type that can, in extreme cases, kill a child within minutes.

Food allergy facts • Two to 2½ percent of the general population suffers from food allergy, or between 6 and 7 million Americans. Up to 3 million Americans suffer from peanut or tree-nut allergy. • Eight foods account for 90 percent of the allergic reactions. They include peanuts, tree nuts (walnuts, pecans, etc.), fish, shellfish, eggs, milk, soy and wheat. • Peanuts are the leading cause of severe allergic reactions, followed by shellfish, fish, tree nuts and eggs. • Physicians are reporting an increase in the number of food-allergic people. • During a reaction, the immune system mistakenly believes that a harmless substance is harmful. When an individual eats that food, that leads to the release of massive amounts of chemicals and histamines that cause symptoms that can include swelling, difficulty breathing, hives, vomiting, loss of consciousness and death. • There are no medications that cure food allergies. Strict avoidance is the only way to prevent a reaction. Most people outgrow food allergies, though peanuts, nuts, fish and shellfish are often considered lifelong allergies. • Individuals with food allergies and asthma appear to be at increased risk for severe allergic reaction. • Most individuals that have had a reaction ate something they thought was safe. • Food allergy is the leading cause of anaphylaxis, or acute allergic reaction, outside the hospital setting, accounting for an estimated 30,000 emergency-room visits and 2,000 hospitalizations each year. • It is estimated that as many as 150 to 200 people die each year from food allergy-related reactions; approximately 50 die from insect-sting reactions. — Source: Food Allergy & Anaphylaxis Network

In the vast majority of school cafeterias, peanut butter remains a staple. It's often what's kept on hand for students who forget lunches or lunch money. This year, the state of Washington will order its usual 80,000 pounds of peanut butter for school-lunch programs, and another 80,000 pounds of roasted peanuts.

But every year, more and more schools and preschools, faced with the danger peanuts pose to a child in their building, decide they can do without them, or at least a lot less of them.

Last year in Seattle, 14 schools asked the district not to send any known peanut products to their kitchens. (No one advertises their menu as peanut-free because peanuts are hidden in so many foods.)

Mercer Island removed all known peanut products from its elementary- and middle-school menus a few years ago, spurred by the 1998 death of a middle-school student who was allergic to walnuts. She didn't die at school, but her death raised awareness all the same.

Last April, the Olympia School District decided to phase peanuts out of its elementary kitchens, and its earthquake food supplies. It quickly added middle and high schools after a middle-school student ended up in the hospital. She ate a muffin that wasn't clearly marked as containing nuts, said Paul Flock, child-nutrition supervisor. That student was OK, he said, but it was scary.

A number of schools set up peanut-free tables in their cafeterias, especially for students with severe allergies, who can react if they touch peanut butter, or inhale peanut dust or fumes. And even though touching it doesn't usually lead to life-threatening reactions, that's not unknown.

And many districts that serve peanuts handle them carefully.

In Northshore, for example, peanut butter is served in individual, lidded containers when it goes to schools where there's an allergic child.

A few schools have taken the controversial step of asking all parents to refrain from sending peanuts in their children's lunch boxes. Some say such requests, while not outright bans, can give a false sense of security, tend to polarize people, and simply aren't effective.

"Banning doesn't work," said Dr. Clifton Furukawa, an allergist at the Northwest Asthma and Allergy Center. "It's not just peanuts; it's wheat, eggs, milk.

"Pretty soon you're banning everything."

Anne Munoz-Furlong, founder of the nonprofit Food Allergy and Anaphylaxis Network (FAAN), adds that the first steps should always be communication and education.

"We have found that if you don't have everybody working together, and an understanding of what the issue is, no plan is going to be effective."

In a few Seattle schools, however, requests to leave peanuts at home seem to work well.

Ben Ostrom, principal at Loyal Heights Elementary, said no parents questioned a newsletter request last year, which included information about the severity of the allergy of one kindergarten student.

"People know that it if were their child, they would want everybody looking out for him," he said.

Gary Tubbs, principal at TOPS, a K-8 alternative school, said that his school's request is just that — a request.

"We don't fuss at anybody if they bring peanuts; that's their right to do so," he said. "This is just out of health and respect."

Loyal Heights and TOPS both have students with severe allergies.

More information Contact the Food Allergy & Anaphylaxis Network (FAAN) in Fairfax, Va., at 800-929-4040, or on the Internet at www.foodallergy.org. FAAN has a set of guidelines for schools dealing with students who have food allergies that outlines responsibilities for the family, the school and the student.

At TOPS, an instructional aide wipes down the peanut-free table in the lunchroom before the allergic student's class arrives. The aide also cleans their classroom desktops and, when the children come back from recess, stands at the door and gives each of them a sanitary towelette to clean their hands.

That's one of the most extensive plans in area schools. At minimum, key staff members are trained how to recognize a reaction, and how to administer a preset shot of epinephrine which, if given appropriately, almost always can prevent death.

What no one wants is a case like one in Spokane last spring. Nathan Walters, 9, died after eating a peanut-butter cookie on a field trip.

Last week, the Spokane School District settled with Walters' family. As part of the agreement, the district will make several policy changes, including training staff better about food allergies and removing peanut-butter cookies from elementary-school menus.

It's not entirely clear why more and more people are diagnosed with peanut allergies. Some evidence suggests dry-roasting is partly responsible, because it makes peanuts more allergenic, said Furukawa.

He also says that carbon in air pollution increases the immune system's reactivity to allergens. And he said more children are getting exposed to peanuts at an earlier age.

Schools are not the only institutions making adjustments. So are airlines and food manufacturers. In Washington, parents helped pass a law that, for the first time, allows emergency-medical technicians to administer epinephrine, not just paramedics.

For parents, the discovery that their child has a life-threatening allergy — whether to peanuts or other foods — usually begins a life of constant vigilance and education. They must read and re-read labels, and explain over and over again to many people — teachers, friends, playmates' parents, flight attendants — what precautions need to be made, and why. And even though the reactions may be mild at first, they have no guarantee that subsequent ones will be.

Sometimes, even the first reaction to peanuts is a terrifying one.

Lisa Hashizume said her daughter, at age 3, quickly reacted after eating just a bit of cracker with peanut butter on it.

"She immediately spit it out and started rubbing her tongue with her hands. I thought it was a texture thing."

But then her eyes swelled shut, her nose started running, and she looked "like a Cyclops," Hashizume said.

When she arrived at the doctor, the staff thought she had been exposed to a chemical.

Handling allergies is difficult when a child is at home all day. When a child hits school age, parents face a whole new set of challenges.

Generally in the Seattle area, each case is handled school by school, based on plans developed by the staff, the physician and the parents.

There are students with mild peanut allergies whose parents are comfortable as long as the staff knows how and when to use epinephrine. There are parents who decide against going to a school if school officials won't agree to leave the shot in the classroom or the lunchroom — so that it can be given as soon as a reaction occurs.

There are some who think it's OK to ask other students not to bring peanuts to school, and those who think that's too much to ask.

"It wouldn't be fair, there are so many more of those (nonallergic) children in the world," said Hashizume.

Parents, school officials and others can get frustrated and angry as they try to balance the right of students to eat what they want, and the rights of those for whom peanut butter is like arsenic.

But more and more, schools and parents are working well together.

"I have not heard much complaining recently that schools aren't cooperating," said Kristin LeClair, founder of the Food Education Allergy Support Team (FEAST), a local support group for parents whose children have food allergies.

"I think they're really starting to grasp the severity of this."

Still, there are issues. When she recently met with FEAST, Jill Lewis, health-services nursing supervisor, said she came away with a list of areas to examine, including buses, field trips, substitute teachers.

LeClair said one of the biggest issues is where to keep the epinephrine. Schools, by law, must keep all medications locked in nurses' offices. But, when a reaction can get very serious in matter of minutes, parents don't want someone fumbling around the office looking for a key. In Seattle, where the shots are kept is negotiated as part of each plan.

Like parents, many schools want to err on the side of caution.

In Olympia, Flock said his kitchen managers had a vigorous debate over whether to remove peanuts from their menus.

Some felt the burden should fall on the allergic child's parents to send in appropriate foods, and teach their children what they can eat. Others lamented, "What next, milk?"

Then, he said, one stood up and said, "I don't want anything to happen to any of my kids on my watch."

That turned the tide, he said, and even though no parents requested it, they decided to start phasing out peanut foods.

And as one cook said, he added, "it wasn't like we were eliminating pizza."

Linda Shaw can be reached at 206-464-2359 or lshaw@seattletimes.com.